I. The goals of treatment of acute mitral valve insufficiency are to reduce left atrial pressure, increase cardiac output, and correct the etiology. Internal therapy is generally a preoperative transitional measure, guided by bedside Swan-Ganz catheter hemodynamic monitoring whenever possible. Intravenous sodium nitroprusside increases cardiac output by dilating small arteries, reducing anterior and posterior cardiac loads, reducing pulmonary stasis, and decreasing regurgitation. Intravenous diuretics reduce preload. If pharmacological treatment is ineffective, intra-aortic balloon counterpulsation may be used. This mechanical method reduces systolic arterial pressure and left ventricular pressure, promotes antegrade flow while reducing regurgitation, increases diastolic aortic pressure and improves left ventricular contractility. Surgical treatment is the fundamental measure, and depending on the etiology, the nature of the lesion, the degree of regurgitation and the response to pharmacological treatment, urgent, elective or elective surgery (prosthetic valve replacement or repair) is performed. In some patients, symptoms can be largely controlled with pharmacologic therapy and enter a chronic compensatory phase. Chronic mitral valve insufficiency (a) Internal treatment 1, prevention of infective endocarditis; rheumatic disease patients need to prevent rheumatic activity. 2, asymptomatic, normal cardiac function does not require special treatment, but should be followed up regularly. 3.The management of atrial fibrillation, except for a few cases of significant deterioration of cardiac function due to atrial fibrillation that require restoration of sinus rhythm, most of them only require satisfactory control of ventricular rate. In chronic atrial fibrillation with a history of embolism in the body circulation and left atrial thrombus seen on ultrasonography, long-term anticoagulation therapy is indicated. 4, heart failure, should limit sodium intake, drug therapy: (1) cardiac agents In patients with mitral valve closure insufficiency, the use of cardiac agents such as digoxin is more important, especially those with atrial fibrillation with rapid ventricular rate. Digitalis drugs can both slow down the ventricular rate and enhance myocardial contractility, which can increase the forward beat volume and relieve clinical symptoms. (2) Diuretics are especially suitable for people with sinus rhythm and enlarged heart, and can improve the symptoms of pulmonary stasis. (3) Arterial vasodilators These drugs reduce the afterload of the heart, increase the forward stroke volume and reduce the regurgitant volume, thus reducing the left atrial pressure. In addition, the reduction in cardiac chamber volume also reduces the size of the mitral annulus and regurgitant orifice. Drugs such as angiotensin-converting enzyme inhibitors or hydrazinoprazine can be used to reduce afterload, which can improve the clinical status of patients with chronic severe mitral valve insufficiency for months or even years. （Patients with acute or chronic moderate-to-severe mitral regurgitation eventually require surgical treatment, and the key is the timing of surgical treatment. If one waits until significant symptoms appear due to left heart failure with hyposystolic left heart function and severe pulmonary hypertension before choosing surgical treatment, the symptoms are often not significantly relieved and left ventricular function still cannot be improved after surgery. In patients with organic mitral regurgitation, surgical indications have evolved toward earlier surgical intervention, which may improve prognosis. It is now widely accepted that surgical treatment should also be considered in some asymptomatic subgroups of patients. The choice of surgical indications should be individualized, but can be broadly grouped into three areas. First, traditional indications Patients with severe symptoms (cardiac function NYHA class III or IV), even if these symptoms are transient or can be improved by pharmacological treatment. These patients can benefit from a significant improvement in postoperative cardiac function, but have also been shown to have excess postoperative mortality independent of other underlying factors. Second, recent indications Patients without or with only mild symptoms (NYHA cardiac function class I or II) but with significant left ventricular function abnormalities: reduced left ventricular ejection fraction (LVEF < 60%), increased left ventricular end-systolic internal diameter (LVESD > 45 mm), increased left ventricular end-systolic volume index (LVESVI > 50 ml/m2), and pulmonary artery systolic pressure > 50 mmHg . In these patients, improvement of volume overload prevents further deterioration of the myocardial condition, but significant left ventricular function abnormalities are accompanied by excessive postoperative mortality independent of other underlying factors. Third, early indications are those patients with severe mitral regurgitation, without or with mild symptoms (cardiac function NYHA class I or II), and without signs of left ventricular insufficiency (left ventricular EF > 60%). The rationale for this indication is as follows: the danger of abnormal LV function secondary to volume overload, which implies a poor prognosis but for which there is no simple, precise, and sensitive method of detection; the significantly higher mortality rate in the setting of conservative treatment, especially the relatively high risk of sudden death; the almost eventual inevitability of surgery in patients with severe mitral regurgitation; and the fact that surgical techniques developments can provide more complete cures; these patients can expect the best outcome from surgery, especially after the acute phase, with survival rates equal to those of the overall population. In our opinion, surgery is a rational choice in this subgroup, but it remains to be widely discussed. In these patients, preoperative quantification of mitral regurgitation should be performed systematically using a variety of noninvasive tests to objectively determine the extent of mitral regurgitation and to confirm the justification for surgery. 2. Preoperative cardiac catheterization and cardiovascular imaging Because of the rapid development of cardiac echocardiography and coronary CTA, cardiac catheterization and cardiovascular imaging are rarely required before surgery for patients with simple mitral valve lesions, which significantly reduces medical costs, alleviates damage to the patient, and shortens the length of hospital stay. In patients with long-term chronic mitral valve insufficiency, whose left heart is significantly enlarged, left heart function is significantly reduced, and pulmonary artery pressure is high, cardiac catheterization helps to determine and evaluate the severity of the valve lesion, pulmonary hypertension, and the functional status of the heart, so as to evaluate the risk and long-term outcome of surgery. For patients whose coronary CTA examination suggests the need for coronary artery bypass grafting, further coronary angiography should be performed. 3, surgical methods (1) valve repair If the valve damage is mild, the leaflets are not calcified, the annulus is enlarged, but the subvalvular tendon cords are not severely thickened, valve repair is feasible, such as mitral valve prolapse, tendon cord rupture, and papillary muscle rupture patients can use repair. Valve repair has a low mortality rate, provides long-term clinical improvement, has a long-lasting effect, has few postoperative infective endocarditis and thromboembolism, does not require long-term anticoagulation (except in patients with concomitant chronic atrial fibrillation), and has a better recovery of left ventricular function (which may be attributed to the preservation of the tendon cords and papillary muscle). Compared with valve replacement, valve repair can be considered at both early and late stages of the disease (when cardiac function is poor), but should not be performed when LVEF is less than 15% to 20%. (2) Prosthetic valve replacement A prosthetic valve must be replaced in cases of leaflet calcification, severe subvalvular structural lesions (such as leaflet deformation and tendon fusion due to rheumatic heart disease), infective endocarditis, or combined mitral stenosis. The current mortality rate of valve replacement surgery is about 5%. Severe left ventricular insufficiency (LVEF ≤ 30% to 35%) or severe left ventricular dilatation (LVEDD ≥ 80 mm and LVEDVI ≥ 300 ml/m2 of increased left ventricular end-diastolic volume index) are no longer suitable for valve replacement. If valve replacement is necessary, left ventricular function can be improved by preserving the integrity of the tendon cords and suturing the papillary muscle to the tendon cords. Valve replacement involves the choice of a biologic or mechanical valve. Generally, the preference for a mechanical valve is due to its long-term reliability. A biologic valve may be chosen when the life span of the valve is not a concern or when the patient wants to avoid long-term anticoagulant use. The latter are often young, sinus-rhythm women who want to become pregnant. They prefer to be treated without anticoagulants – replacement of the bioprosthetic valve is a viable option. However, these patients must be aware that the bioprosthetic valve must be replaced again after 15 to 20 years of use because of valve failure. In general, patients without contraindications to anticoagulant use should be treated with long-term anticoagulation regardless of the type of valve used. Mitral valve replacement has a higher incidence of systemic thrombosis than aortic valve replacement (although bioprosthetic valves have a lower incidence); in mitral valve replacement bioprosthetic valve cases not treated with anticoagulation, the incidence of thrombosis remains 1 to 3 percent per year. Some clinicians recommend aspirin therapy for bioprosthetic valve replacement patients who do not wish to use anticoagulants. Some data suggest that aspirin therapy is effective, but it is unclear whether it has the same anticoagulant effect as warfarin. (3) Treatment of combined atrial fibrillation Patients with chronic mitral valve lesions are often combined with significant enlargement of the left atrium and atrial fibrillation.